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• W2021569628 abstract "Context and setting Telemedicine using a real-time videolink is an effective way of making a diagnosis and management plan for neurological outpatients. Serendipitously, we have found that it is also very useful for teaching medical students about patient consultation and neurological diagnosis. Why the idea was necessary Although teaching about patient consultation and neurological diagnosis can be achieved conventionally by having students sit in at a clinic, this is unwieldy with more than four students. In addition, our neurology attachment has been reduced to 2 part-time weeks in Year 3 of a 5-year course and the number of students in each group has increased to about 27, although the number of teachers has not risen. This makes conventional clinic teaching less viable. A video-linked consultation, however, can accommodate up to 15 students with the doctor. What was done We devised a system where the neurologist first explains to the students about the pivotal importance of diagnosis in medicine, and about how it is derived from history taking, examination and, if necessary, investigation. She explains about each neurological symptom and how it is important to know about the finite number of responsible diseases. She explains briefly about the forthcoming videolink consultation with a patient and teleneurology nurse at a distant hospital, and shares her enthusiasm for the new patient consultation. The referral letter is then discussed, possible causes of the symptoms put into an order of likelihood and the neurologist explains some of the questions she will ask. The videolink is then established and the neurologist introduces herself and the medical students before changing her camera view to make the students disappear and show only herself; this lessens the patient’s awareness of the students as the consultation progresses. The neurologist then takes the history. If something of importance is said, the neurologist is able to ask the patient to excuse her for a minute, mute her microphone, and translate the patient’s utterance into a pearl of clinical wisdom. This ability to mute the microphone is crucial and enables teaching to proceed without detriment to the clinical process; discussions about the likely diagnosis can take place after the history and explanations about the anatomical significance of each test can be given during the examination (which is performed by an experienced nurse with the neurologist watching). After the examination the neurologist and students discuss the likely diagnosis, whether any tests are needed and how the patient will be informed. The patient is then told the neurologist’s opinion and is able to ask questions. Once the questions have been answered, the patient leaves. The consultation as a whole is then discussed with the students. Two patients are seen in each session, after which the neurologist suggests some further reading and indicates where the students might find it. Evaluation of results and impact Patients are unfazed by the presence of students and are grateful for the extra 15 minutes or so allowed by the consultation schedule. All 15 students who replied to an e-mail questionnaire felt they had learned about neurological symptoms, 14 had learned about how doctors deal with patients and none had been put off by the technology. Videolink consultations can be performed in disciplines other than neurology and have the potential to preserve this method of clinical teaching for future generations of medical students." @default.
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• W2021569628 date "2008-11-01" @default.
• W2021569628 modified "2023-10-16" @default.
• W2021569628 title "Teaching neurology by videolink" @default.
• W2021569628 doi "https://doi.org/10.1111/j.1365-2923.2008.03187.x" @default.
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